Provider Demographics
NPI:1497881379
Name:PAIN CENTER OF NORTH JERSEY PC.
Entity Type:Organization
Organization Name:PAIN CENTER OF NORTH JERSEY PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMS
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-473-4040
Mailing Address - Street 1:1084 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2330
Mailing Address - Country:US
Mailing Address - Phone:973-473-4040
Mailing Address - Fax:973-249-9988
Practice Address - Street 1:1084 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2330
Practice Address - Country:US
Practice Address - Phone:973-473-4040
Practice Address - Fax:973-472-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0083497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090206Medicare ID - Type Unspecified